The short title of the act is the "Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991." The provisions amend title XIX of the Social Security Act.

Prohibition on the Use of Voluntary Contributions, and Limitation on the Use of Provider-Specific Taxes to Obtain Federal Financial Participation under Medicaid (Section 2)

Subsection (w) is added to section 1903 of the Social Security Act. In general, as of January 1, 1992, this subsection denies Federal matching funds for almost all donations from health care providers and limits Federal matching funds for health care related taxes. Certain transition provisions are provided for donation programs in effect on September 30, 1991, for State fiscal year 1992 and for health care related taxes in effect or enacted as of November 22, 1991.

The total amount of Federal matching funds for Medicaid medical assistance expenditures is reduced by the sum of any revenues received by the State (or unit of local government) during the fiscal year from impermissible provider-related donations and health care related taxes as described below.

* Federal matching funds are not available for provider-related donations except for bona fide provider-related donations and for donations for outstationed eligibility workers.

Provider-related donations are any donations or other voluntary payments (in cash or in kind) made directly or indirectly to a State or unit of local government by a health care provider, an entity related to a health care provider, or an entity providing goods or services under the State plan and paid as administrative expenses.

Bona fide provider-related donations are donations that the Secretary of Health and Human Services determines have no direct or indirect relationship to payments made under this title. Regulations may be issued that more clearly define bona fide provider-related donations.

Donations for outstationed eligibility workers are funds expended by a hospital, clinic, or similar entity for the direct cost (including costs of training and outreach materials) of State or local agency personnel who are stationed at the entity to determine Medicaid eligibility and to provide outreach services to eligible or potentially eligible individuals. Beginning in Federal fiscal year 1993, these donations are limited to 10 percent of a State's total administrative expenditures (Federal and State) for Medicaid during the fiscal year.

Health care related taxes include taxes that are related to health care items or services or to the provision of such items or services. Taxes that are related to the authority to provide health care items or services or the payment for such items or services are also considered to be health care related taxes.

A tax is considered to relate to health care items or services if at least 85 percent of the burden of such tax falls on health care providers. A tax that is not limited to health care items or services but provides different treatment for individuals or entities that are providing or paying for such services is also considered a health care related tax.

Taxes that are uniformly imposed on all non-Federal, non-public providers in a class and all business of providers in that class are considered to be broad-based health care related taxes. A health care related tax may exempt Medicaid and/or Medicare providers, revenues, or receipts and still qualify as a broad-based health care related tax.

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